吲哚菁绿荧光显影技术在腹腔镜结直肠癌根治术中的应用效果分析  

Analysis of the application effect of indocyanine green fluorescence imaging technology in laparoscopic radical resection of colorectal cancer

作　　者：陈志良[1,2] 张维富 刘永锋[1] 杨梓锋 冯伙伦 吕泽坚 吴德庆[1] 李勇[1] Chen Zhiliang;Zhang Weifu;Liu Yongfeng;Yang Zifeng;Feng Huolun;LüZejian;Wu Deqing;Li Yong(Department of Gastrointestinal Surgery,Guangdong Provincial People’s Hospital Affiliated to Southern Medical University/Guangdong Academy of Medical Sciences,Guangzhou 510080,Guangdong,China;Department of Gastrointestinal Surgery,The Tenth Affiliated Hospital of Southern Medical University/Dongguan People’s Hospital,Dongguan 523058,Guangdong,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)胃肠外科,广东广州510080 [2]南方医科大学第十附属医院(东莞市人民医院)胃肠外科,广东东莞523058

出　　处：《结直肠肛门外科》2024年第1期72-75,共4页Journal of Colorectal & Anal Surgery

基　　金：国家临床重点专科建设项目 (2022YW030009)。

摘　　要：目的分析吲哚菁绿荧光显影技术在腹腔镜结直肠癌根治术中的应用效果。方法回顾性分析2020年8月至2023年10月在腹腔镜结直肠癌根治术术中应用吲哚菁绿荧光显影技术辅助判断吻合口处的血供的44例患者的临床资料。记录并分析术中吲哚菁绿荧光显影情况,手术相关指标(手术时间、术中出血量、术中淋巴结清扫数目)和术后并发症(吻合口漏、肠梗阻、吻合口出血、腹腔感染、尿路感染、肺炎)。根据患者术后是否发生吻合口漏,将患者分为吻合口漏组与无吻合口漏组,分析两组吻合口处的吲哚菁绿荧光显影相关指标,包括荧光强度峰值(F_(MAX)),荧光强度达峰时间(T_(MAX))与荧光强度达半峰时间(T_(1/2MAX)),以及荧光强度随时间变化的上升曲线的斜率(“曲线斜率”)。结果34例(77.3%)患者术中吲哚菁绿荧光显影良好,10例(22.7%)患者术中吲哚菁绿荧光显影欠佳或较差。44例患者中,平均手术时间为(220.5±44.4)min;中位术中出血量为20(20,45)mL;中位术中淋巴结清扫数目为13.5(12.0,18.0)枚。术后并发症方面,5例患者术后发生吻合口漏,其中3例患者术中吲哚菁绿荧光显影良好、2例患者术中吲哚菁绿荧光显影较差;1例患者出现肠梗阻,1例患者出现吻合口出血;无其他并发症。两组的F_(MAX)、T_(MAX)、T_(1/2MAX)比较差异无统计学意义(P>0.05);无吻合口漏组的曲线斜率大于吻合口漏组,差异有统计学意义(P<0.05)。结论吲哚菁绿荧光显影技术在腹腔镜结直肠癌根治术中具有一定的应用价值,总体手术安全性良好。Objectives To analyze the application effect of indocyanine green fluorescence imaging(ICG-FI)technology in laparoscopic radical resection of colorectal cancer.Methods The clinical data of 44 patients who underwent laparoscopic radical resection of colorectal cancer with ICG-FI technology to assist in assessing the blood supply at the anastomosis site from August 2020 to October 2023 were retrospectively analyzed.The intraoperative ICG-FI,surgical indicators(operation time,intraoperative blood loss,number of intraoperative lymph node yield),and postoperative complications[anastomotic leakage(AL),ileus,anastomotic bleeding,abdominal infection,urinary tract infection,pneumonia]were recorded and analyzed.The patients were divided into an AL group and a non-AL(NAL)group based on whether AL occurred postoperatively.The relevant indicators of ICG-FI at the anastomosis site in these two groups were analyzed,including fluorescence difference between maximum and baseline(F_(MAX)),time from first fluorescence increase to maximum(T_(MAX)),time from first fluorescence increase to half of maximum(T_(1/2MAX)),and the slope of the ascending curve of fluorescence intensity over time(“curve slope”).Results Thirty-four(77.3%)patients had intraoperative good ICG-FI,whereas 10(22.7%)patients with intraoperative poor or inadequate ICG-FI.Among the 44 patients,the mean operation time was(220.5±44.4)minutes;the median intraoperative blood loss was 20(20,45)mL;and the median number of intraoperative lymph node yield was 13.5(12.0,18.0).Postoperative complications included AL in 5 patients,with 3 patients having intraoperative good ICG-FI and 2 patients having intraoperative poor ICG-FI;ileus occurred in 1 patient;and anastomotic bleeding occurred in 1 patient.No other complications occurred.There was no significant difference in F_(MAX),T_(MAX),and T_(1/2MAX) between the two groups(P>0.05);the curve slope of the NAL group was greater than that of the AL group,and the difference was statistically significant(P<0.05).Conclusion ICG-F

关 键 词：结直肠癌 腹腔镜手术 吲哚菁绿 吻合口漏 

分 类 号：R735.3[医药卫生—肿瘤]